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Updated: Jun 27, 2025

Murine Prostate Micro-dissection and Surgical Castration
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Elevated periprostatic androgens, sneaky testosterone and its implications.

Masoud Bitaraf1, Ranjith Ramasamy1, Sanoj Punnen1,2

  • 1Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Nature Reviews. Urology
|May 7, 2024
PubMed
Summary
This summary is machine-generated.

Men with prostate cancer may experience elevated periprostatic androgens, known as the sneaky T phenomenon, linked to poorer outcomes. Varicocele may contribute to this phenomenon, suggesting a potential role for varicocele repair.

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Area of Science:

  • Urology
  • Andrology
  • Oncology

Background:

  • A subset of prostate cancer patients exhibit elevated periprostatic androgens compared to peripheral levels, termed the sneaky T phenomenon.
  • This phenomenon is associated with adverse clinical outcomes following radical prostatectomy.
  • Periprostatic androgen elevation is hypothesized to originate from testicular sources and reach the prostate via venous shunting.

Purpose of the Study:

  • To explore the potential mechanistic link between varicocele physiology and the sneaky T phenomenon in prostate cancer.
  • To investigate if varicocele could be a contributing factor to prostate cancer pathophysiology via sneaky T.
  • To determine if the sneaky T phenomenon could inform therapeutic decisions for prostate cancer.

Main Methods:

  • Observational study comparing periprostatic androgens to peripheral levels in prostate cancer patients.
  • Analysis of varicocele physiology and its association with pelvic venous system pressure.
  • Theoretical modeling of androgen transport from testicular to prostatic tissue.

Main Results:

  • The sneaky T phenomenon, characterized by elevated periprostatic androgens, is observed in a subset of prostate cancer patients.
  • Varicocele physiology presents increased hydrostatic pressure in the pelvic venous system, offering a potential mechanism for sneaky T.
  • The findings suggest a theoretical pathway for varicocele influencing prostate cancer through sneaky T.

Conclusions:

  • Varicocele may play a role in prostate cancer development or progression through the sneaky T phenomenon.
  • Confirmation of this link could establish varicocele repair as an additional therapeutic consideration.
  • Understanding sneaky T may aid in differentiating disease trajectories and guiding treatment strategies for prostate conditions.